Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare

Augustsson, Hanna; Churruca, Kate; Braithwaite, Jeffrey

doi:10.1186/s12913-020-05929-5

Cited by 22 publications

(19 citation statements)

References 49 publications

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“…There is a large body of literature describing frameworks and approaches to evaluate complex systems and facilitate system level change [ 24 – 29 ]. A recent review examined public health evaluations exploring the different complex system methodologies used and the utility of evidence generated [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Confronting complexity and supporting transformation through health systems mapping: a case study

Hussey¹,

Sibbald

Ferrone

et al. 2021

BMC Health Serv Res

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Introduction Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat. Study description This case study documents the first phase of system transformation at a regional level in Ontario, Canada. In this first phase, visual representations of the health system in its current state were developed using a collaborative co-creation approach, and a focus on COPD and HF. Multiple methods were used including focus groups, open-ended questionnaires, and document review, to develop a series of graphical and visual representations; a health care ecosystem map. Results The ecosystem map identified key sectoral components, inter-component interactions, and care requirements for patients with COPD and HF and inventoried current programs and services available to deliver this care. Main findings identified that independent system-wide navigation for this vulnerable patient group is limited, primary care is central to the accessibility of nearly half of the identified care elements, and resources are not equitably distributed. The health care ecosystem mapping helped to identify care gaps and illustrates the need to resource the primary care provider and the patient with system navigation resources and interdisciplinary team care. Conclusion The co-created health care ecosystem map brought a collective understanding of the health care system as it applies to COPD and HF. The map provides a blueprint that can be adapted to other disease states and health systems. Future transformation will build on this foundational work, continuing the robust interdisciplinary co-creation strategies, exploring predictive health system modelling and identifying areas for integration.

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Section: Introductionmentioning

confidence: 99%

Confronting complexity and supporting transformation through health systems mapping: a case study

Hussey¹,

Sibbald

Ferrone

et al. 2021

BMC Health Serv Res

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“…The models may also be valuable for providing the necessary insights regarding proactive project risks and patient safety management during implementation [ 34 ] as well as for guiding clinical and project evaluations [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting

Aminoff¹,

Meijer²,

Arnelo³

et al. 2021

JMIR Form Res

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Background A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative “discovery and modeling” approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment.

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“…The present study aimed to achieve an understanding of complex situations and visualization of challenges in communities for healthcare coordinators to link the healthcare delivery system and the long-term care delivery system. Among the seven stages of SSM, we used up to the fourth stage to qualitatively analyze the data [ 12 , 13 , 14 ]. This time, it was grasped from the discussion materials and structured reports how each coordinator perceived the problem situation of the people needing care.…”

Section: Methodsmentioning

confidence: 99%

Using the Soft Systems Methodology to Link Healthcare and Long-Term Care Delivery Systems: A Case Study of Community Policy Coordinator Activities in Japan

Goto

Miura

2022

IJERPH

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Due to the rapidly aging population in Japan, the government has been attempting to link the healthcare delivery system with the long-term care delivery system. However, there are complex challenges that must be overcome to link the two systems. A new methodology should be used to organize complex community challenges and propose solutions. This study aimed to visualize the unique challenges and worldviews of interested parties in each community, using the soft systems methodology (SSM). We aimed to visualize issues and clarify challenges associated with linking the healthcare and long-term care delivery systems; in turn, clarifying the thought process behind solution proposals. We gathered information regarding those who are actively linking these systems in communities in a Japanese municipality (community care coordinators) and organized the information according to the SSM procedure. By organizing information using the SSM, we were able to summarize the present situations of the community healthcare and long-term care delivery systems, visualize issues, clarify challenges associated with linking these two systems, and propose solutions. The SSM may be useful in organizing complex community information and deriving solutions.

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Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare

Cited by 22 publications

References 49 publications

Confronting complexity and supporting transformation through health systems mapping: a case study

Confronting complexity and supporting transformation through health systems mapping: a case study

Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting

Using the Soft Systems Methodology to Link Healthcare and Long-Term Care Delivery Systems: A Case Study of Community Policy Coordinator Activities in Japan

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